(a) Population Size, Growth, Composition and Distribution

India is the second largest country of the world, in terms of population, after China. Although India was one of the first countries of the world to have an explicit population policy the Indian performance so far is more of a failure than a success. At present it has nearly 18 per cent of the total world population, while it accounts for only 2.5 per cent of the world’s total land area. In any demographic miscellany growth of population occupies the most important place.

The first formal census enumeration was taken up in 1881 and since then the decennial census enumeration exercise has been a regular feature involving a high degree of expertise and substantial manpower. The offices of the Census Commissioner and the Registrar General of India have been responsible for providing the demographic profile of the country. As per the 2011 census, the total population of India is about 121 crores, an increase of about 17.64% in the last 10 years (2001 census).

According to the demographers the major cause for increase in population is the rapid fall in death rate. According to 1991 census, birth rate in the country was 30.0 per thousand and death rate 10.0 per thousand population while the figure for next approximately two decade in 21.76 (2009 est.) and 6.4 (2009 est.) per thousand populations. Thus the birth rate as well as the death rate have registered fall, though marginally. But this marginal improvement is not enough because of the gigantic level of population India has achieved over the years.

When we take up the density of population in India we come across significant findings. Density of population means the number of people living per sq. km. Density of population of the present area (adjusted for partition of India in 1947), increased from 77 persons per sq. km. in 1901 to 382 persons per sq. km in 2011. Thus it shows an increase of almost 4.9 times. The density of population in India can be categorized as following:

(1) The lowest density was found in Arunachal Pradesh where only 10 persons inhabit per sq. km. Other low-density states are Mizoram, Andaman and Nicobar Islands, Sikkim, Jammu and Kashmir, Meghalaya, Nagaland, Manipur and Himachal Pradesh. All the eastern states, except Assam and Tripura, have low density and so do the hilly states like Himachal Pradesh and Jammu and Kashmir.

(2) Delhi, Chandigarh and Pondicherry have the highest density.

(3) States, which have population density of three times the national average are Daman and Diu. States, which have two times or more, are Kerala and West Bengal. (4) States which have population density above national average are Assam, Bihar, Goa, Haryana, Punjab, Tamil Nadu, Uttar Pradesh, and Dadra and Nagar

Haveli.

(5) States, which have population density lower than the national average, are Andhra Pradesh, Gujarat, Karnataka, Maharashtra and Tripura.

Components of Population Growth: Birth, Death, Migration

Three main determinants of population growth is

(1) Birth rate

(2) Death rate

(3) Migration rate

The main factors affecting the population change are the birth rate, death rate and migration. The birth rate is the number of live births per 1000 of the population in a year. The death rate is the number of deaths per 1000 of the population in a year. Migration is the number of people moving in (immigration) or out (emigration) of a country, place or locality. The population change is calculated by the formula: Population change = (Births + Immigration) – (Deaths + Emigration) [Difference between birth rate and fertility rate : Birth rate is how many live births there were in an area per 1000 of the population in a year. and Fertility rate is the average number of children born to each woman over the course of her life (reproductive age : 15 to 49 years). 20.22 births/1,000 population (2013 est.); 7.4 deaths/1,000 population (2013 est.); Life expectancy: 68.89 years (2013 est.)]

(a) Birth rate (in India)

Birth is a biological process, but birth rate is not only influenced by biological elements instead it is also effected by social-cultural, religious and economic circumstances. This is the reason that birth related data contains some uniqueness. (20.22 births/1,000 population (2013 est.) Illiteracy is one of the most important factors of high birth rate. It has been found that in literate family the fertility rate is not only low in comparison to illiterate families, but it also declines with the increase in education. This is one of the most important factors of high fertility rate among Muslims. Muslim women have lower literacy rate than national literacy rate, this lowers their status and limits decision-making abilities. Among Muslims Prada System is strictly followed and so it becomes a hurdle in their education. [National Sample Survey has revealed that fertility rate among illiterates and elementary (primary) level educated women is 7.7, the rate is 5.6 among middle class educated, and college level educated women had fertility rate of 2.0. It is clear from this illustration that one of the biggest factors of high fertility rate in our country is illiteracy.]

Socio-cultural structure of communities has influence in birth rate. The customs of polygamy and remarriage in Muslims is also a hindrance in lowering birth rate. Another reason of not controlling the fertility rate among Muslims is their religious belief, that controlling birth is unnatural. Thus, in this community preventive measure of birth control is prohibited. These factors have contributed in maintaining high birth rate and population growth in this community. According to a 2006 committee appointed by the Indian Prime Minister, if the current trend continues, by the end of the 21st century India's Muslim population will reach 360 to 390 million people (or 21% of India's total projected population).

Third largest population in India is of Christians (it is 2.3 per cent of the total population). In this religion also birth rate is very high. Here, religious and cultural factors played a crucial role. Though the abortion is legal in India since 1971, but Christianity considers it non-religious and unnatural action, thus it does not have a religious sanction. Second significant reason of high birth rate is remarriage. Other factor of high birth rate in Christianity is religious conversion, mainly of the tribal people. In spite of religious conversion these people are unable to discard their tribal customs, religious and cultural traditions in totality. Therefore, because the Indian tribal birth rate is the highest, so in spite of high literacy rate in Christianity they have very high birth rate. Indian Hindu majority community also has a high birth rate. Various religious and social orthodoxy is the factor behind it. In Indian society begetting a son is essential to get Moksha (Salvation). Thus, sometimes a woman is forced to give birth to numerous girls in search of a son. The society considers children as a gift of God. So, the people hesitate to have a voluntary control of child birth. Specially, in lower strata, children are considered as an economical asset, the more children the more will be the income. However, increasing literacy and comparatively more women liberty, and reasonable degree of acceptance of birth control measures among Hindu communities have proved helpful in lowering birth rate.

(b) Death Rate

Death rate is the ratio of total deaths to total population in a specified community or area over a specified period of time. [The death rate is often expressed as the number of deaths per 1,000 of the population per year.] This is also called fatality rate. (7.4 deaths/1,000 population (2013 est.))

Death rate reflects country’s general standard of (Factors affecting death rate are) - Medical facilities and health care, Nutrition levels, Living standard, Access to clean drinking water, Hygiene levels, Levels of infectious diseases etc. Due to improvement in science and technology the level of abovementioned elements have increased resulting in decrease in death rate. These development is good for the economy and society of India, but strictly in terms of population, this advancement has further enhanced the increase in population.

The average life expectancy of people in India has increased from 52.9 in 1975 to 68.89 years in 2009 est.. Although our near and dear ones would live longer, due to the increase in the population, the resources available per person would be much less, leading to a decrease in the overall development. Lowering of death rate has increased old age population in our country. It is estimated that the absolute number of the over 60 population will increase to 137 million by 2021.

(c) Migration

Migration is the movement of people from one place to another to stay on for a considerable period of time for various reasons. There are two main types of migration: first, internal migration (immigration), i.e. migration within one country, and secondly international migration (emigration), which means the movement from one country to another.

Migration is the third component of population change, the other two being birth rate and death rate. It is influenced by social, cultural, economic and political factors. Planners and policy-makers are concerned with migration because it is associated with the socio-economic development of the country. In India and in many other developing countries, one of the side-effects of unprecedented population growth is industrialization and economic development which helped in a rapid increase in internal migratory movements. The emergence of such a massive population phenomenon, especially that of rural-urban migration, has attracted the attention of planners and policy-makers to the problems arising out of migration. The Indian Planning Commission recommended as early as in 1956 that studies should be undertaken on problems related to regional development, with special reference to problems of rapid urbanization.

Reasons of Migration: Push and Pull factors

Among the various push factors operating at the place of origin may be included as following: high natural rate of population growth creating population pressure on the existing resources; exhaustion of natural resources, droughts, floods, natural calamities, such as earthquakes and famines; and acute social, religious or political conflicts compelling people to migrate to other places for reasons of safety.

The following may be included as the pull factors: establishment of new industries with the provision of new opportunities for gainful employment; facilities for higher education in cities; pleasant climatic conditions, the bright sides of the city life and other various amenities.

The push-pull approach has been useful in listing the several factors which affect migratory movements and explains the migratory phenomena. The major trend in Indian migration is rural-urban i.e. migration from rural area to urban area. This is due to lack of basic amenities in rural areas, and relatively better opportunities in urban areas. Leading to rapid urbanization and related problems.

Population Policy and Family Planning

In India, the concern with population dates back to pre-independence period. In 1916 P.K.Vattal titled “population problems in India”. Many individuals like Prof. Kharve, Rabindranath Tagore etc. were concerned about the issue of controlling population growth. National planning committee setup by INC in 1935 made recommendations and that unrestricted increase of population needs to be checked and that planning of family and limitation of children was essential. Numbers of voluntary efforts were made in 1930’s and 1940’s to establish birth control clinics. At least in elite, there was a concern about population control.

India has the unique distinction of being the first country to initiate population control measures. Population control was envisaged in the 1st Five Year Plan (FYP) itself. But we didn’t frame a population policy. Our concern was regarding population control. In the 1st FYP, we made symbolic gesture, that in the entire plan period of 5 years, we spent Rs. 14.5 Lakhs. In 1951, we had 361mn population in India. By 1956 it would have been around 400mn. On an average, we spent Rs. 3 Lakhs/year and 13 paisa/person/year. So, it is highly inadequate and because of the poor allocation we couldn’t achieve mightily results. Rajkumari Amrit Kaur was the health minister during 1st FYP who was a Gandhian she at best tried to open a few clinics. This period was known as clinical approach.

We didn’t realize that Indian worship fertility. We extol fertility. As infant mortality was

high, parents wanted children. So, people had no incentive for family planning. People in India saw children as assets not as a liability. There was only academic significance regarding family planning, but on ground nothing substantial was done.

In the 2nd FYP, we spent Rs. 2.2 crores. But there was no policy even now. 1961 census, which was also end of 2nd FYP, was an eye opener. We recorded a growth rate of 1.96% we woke up as things were going out of control. The 3rd FYP, it (1961-66) emphasized objective of stabilizing growth of population over a reasonable period; must be at centre of a planned effort. So, there were no specific/well defined targets even by 3rd FYP. But we spent an amount of Rs. 15 crores which was a significant amount in comparison with 1st and 2nd FYP. Indira Gandhi was always serious about family planning. In the plan holidays between

1966-69, there was Rs. 70 crores spent on family planning programmes, our main stay was of permanent family planning methods like sterilization. In fourth FYP, we

emphasized on limiting family size to 2 or 3. By now we added the extension approach to the existing clinical approach. Extension was in terms of advertising, educating and spreading awareness among masses to limit family size.

BY 4th FYP, we also had the camp approach. That is when Kerala took the initiative. Krishna Kumar, collector of Ernakulum district took initiative to launch a District family planning camp. It was extended in other parts of country also. It was mainly planning at door step. In the 1st camp about 15000 operations were done and in 2nd camp, 64,000 operations were done at Ernakulum. There was total acceptance environment for family planning programmes. Also various incentives were offered. Similar approach was taken up by T.V. Antony a district collector in Tamil Nadu. Later Krishna Kumar was made health minister by Indira Gandhi.

So, far the thinking was that, people are irresponsibly productive; they thought to control population by sterilization. At no stage was it realized that the whole problem is a population problem but not a fertility problem. Problem is about high infant mortality rate (IMR), no contraceptives, early age of marriage, and lack of awareness. This was never addressed.

5th FYP added some positive content to the family planning programme. It talked about maternal health and child nutrition. Poor health of mother leads to high Maternal mortality rate (MMR) and high IMR. A child born to a mother who is less than 18 years of age has less chance of survival.

Only when mother is above age of 18, the child has good chance of survival, as the reproductive system in female will take/get a complete shape by this age. The poor quality of population is responsible for high quantity. This was realized in 5th F.Y.P. Maternal health care and child nutrition were added to family planning programmes. Immunization against DTP started. There was vaccination against tetanus. Prophylaxis treatment against blindness caused in children due to vitamin ‘A’ deficiency. Dietary supplements for women to prevent anemia. And the rest of the programme was about preventing child birth.

In 1976, for the first time we had a National population policy. We started to have an organized approach to tackle this problem. Important objectives of 1976 policy were:

(1) Raising age of marriage boys and girls

(2) Freezing representation of seats in Lok Sabha till 2001 as an incentive.

(3) Family planning was a state subject. So, 8% of central assistance was linked to family planning as an incentive.

(4) Special measures for female education and non-formal education for women.

(5) Special efforts to motivate citizens for responsible reproductive behavior.

(6) Increase in incentives for sterilization.

(7) Involvement of NGO’s in implementing family planning programme.

(8) Allowing state legislation to make laws for compulsory sterilization.

(9) Massive motivational strategy to adopt family planning.

(10) Incentives to government employees to adopt small family norms.

Emerging Issues: Ageing, Sex Ratios, Child and Infant Mortality, Reproductive Health

Defining Ageing in India

In India, Ministry of Social Justice and Empowerment, Government of India adopted

“National Policy on Older Persons’ in January, 1999. The policy provides broad guidelines to State Government for taking action for welfare of older persons in a proactive manner by devising their own policies and plans of action. In India, the policy defines ‘senior citizen’ as a person who is 60 years old or above. [Definition: Age dependency ratio is the ratio of dependents--people younger than 15 or older than 64--to the working-age population--those ages 15-64.]

Population ageing is the most significant result of the process known as demographic transition. Reduction of fertility leads to a decline in the proportion of the young in the population. Reduction in mortality means a longer life span for individuals. Population ageing involves a shift from high mortality/high fertility to low mortality/low fertility and consequently an increased proportion of older people in the total population. India is undergoing such a demographic transition.

In 1947, when India became independent from British rule, life expectancy was around 32 years. Improvements in public health and medical services have led to substantial control of specific infectious diseases which translated into significant decreases in mortality rates. Life expectancy at birth rose steadily and by 2009 (est.) had reached 68.89 years (72.61 for females and 67.46 for males).

[Improved sanitation, increased attention to maternal health and better child care facilities greatly reduced infant mortality. Government sponsored family planning measures made some impact, especially in urban areas.]

The Indian aged population is currently the second largest in the world. The absolute number of the over 60 population in India is expected to increase to 137 million by 2021.

Problems related to Ageing

Health and Morbidity

The leading cause of death in old age in India is cardiovascular disease (CVD). Earlier in life, infections are still the leading causes of death but among older people most deaths are due to non communicable diseases. Age related changes in immune system render people susceptible to a variety of infections and tumours. Though tuberculosis related mortality has declined, it is still not eradicated effectively and the prevalence rate is reported to be higher in the older age group.

Mental Health

The risk of senile dementia increases with age. As the country moves from being ‘youngold’ to ‘old-old’, senile dementia of Alzheimer’s type may become a major problem of the 21st century (Venkoba Rao, 1997). Affective disorders in later age in India, particularly depression, late paraphrenia and dementias form the bulk of total mental morbidity. Psychiatric illness is seldom an isolated event among elderly people.

Economic conditions and social security for older people

India, with its predominantly agrarian based economy, has inadequate social security

provisions for its older people. The concept of social security implies that the state should make itself responsible for ensuring a minimum standard of material welfare to all its citizens. Social security schemes are available in India mainly for those retiring from the organized sector. Ninety per cent of the total work force, however, is employed in the informal sector. National old age pension schemes (NOAPS) provide assistance to destitute persons above 65 years (Rs.300 and above 80 years of age Rs.500 per month). It is obvious that older people have to depend mostly on their own earnings/savings or on their family. People employed in agriculture sector continue to work as long as they physically manage the job. In urban areas, retired men may take up part time jobs, if available, to supplement their incomes. A vast majority of women are housewives, and as such, ‘invisible workers’, depend on their families. Women’s work is hardly quantified and monetized.

Families and living arrangements

Living arrangements of older people are influenced by several factors such as gender, health status, presence of disability, socio-economic status and societal traditions. Generations of older Indians have found shelter in the extended family system during crises, be these social, economical or psychological. However, the traditional family is fast disappearing, even in rural areas. With urbanization, families are becoming nuclear, smaller and are not always capable of caring for older relatives. Yet, in India, older people are still cared for by their families. Living in old age homes is neither popular nor feasible. Allowing parents to live in old age homes draws criticism from the family network and society at large.

Issue of Sex Ratio

We started the 20th century with a sex ratio of 972 women /1000 men but after 100 years, it was 933 and in 2011 the sex ratio is 940 women/1000 men. Over the years we noted that sex ratio has become adverse for women barring state of Kerala. Even in case of Kerala, sex ratio looks positive, perhaps due to the reason that many men have migrated to Middle East.

India’s history of 20th century is the history of vanishing women. In 2011, sex ratio became 940/1000 but this is a marginal improvement. Scholars consider that the increase in sex ratio is also due to increase of longevity of women. In a society characterized with inequality, modernization process adversely affects the most vulnerable sections of society. This problem is acute in rich and educated states as modern technology like ultrasonography is working at disadvantage of women. Jean Dreze formulate Female disadvantage index (FDI). He reports that entire North India especially BIMARUO region is bastion of patriarch. The highest FDI is in Chandigarh followed by Rajasthan, Bihar, and Uttar Pradesh and Madhya Pradesh. The goal of family planning and modernization should be at small size of family and access to health facilities. But they both are working against women. This disbalance can have very serious social consequences. Success of population policy may bring new problems.

Causes of Uneven Sex Ratios

Cultural Context

Underlying causes of gender inequality lie with prevailing cultural beliefs and gender

norms that promote the devaluation of women and social domination of men.

Patriarchal society

Patriarchy is a social system of privilege in which men are the primary authority figures, occupying roles of political leadership, moral authority, control of property, and authority over women and children. Most of India, with some exceptions, has strong patriarchal and patrilineal customs. Examples of patriarchy in India include prevailing customs where inheritance passes from father to son, women move in with the husband and his family upon marriage, and marriages include a bride price or dowry. This 'intergenerational contract' provides strong social and economic incentives for raising sons and disincentives for raising daughters.

Son preference

A key factor driving gender inequality is the preference for sons, as they are deemed

more useful than girls. Boys are given the exclusive rights to inherit the family name and properties and they are viewed as additional status for their family. They are also believed to have a higher economic utility as they can provide additional labour in

agriculture. Another factor is that of religious practices, which can only be performed by males for their parents' afterlife. All these factors make sons more desirable. Moreover, the prospect of parents ‘losing’ daughters to the husband’s family and expensive dowry of daughters further discourages parents from having daughters.

Dowry

In India, dowry is the payment in cash or some kind of gifts given to bridegroom's family along with the bride. The practice is widespread across geographic region, class and religions. The dowry system in India contributes to gender inequalities by influencing the perception that girls are a burden on families. Such beliefs limit the resources invested by parents in their girls and limits her bargaining power within the family.

Health and Survival

Some of the greatest examples of gender inequality in India are with health and survival measures of the population.

Mortality and Natality inequality

Despite a biological advantage over men for longevity and survival there are more men in India than women India. The chief reason of low sex ratio of women is that many are never born and those who are, die prematurely due to discrimination. This has given rise to the term "India's Missing Women", coined by Amartya Sen. By applying Sen's calculations, the The Hindu estimates that over the past 50 years, 68 million women are missing and those rates are not decreasing. Sex selection before birth and neglect of the female child after birth, in childhood and, during the [teenage] years, has resulted in males outnumbering females in India. In North America and Europe the sex ratio of the population is 105 women per 100 men; in India, the ratio in 2011 was 940 women per 1,000 men, with some states as low as 618 (Daman Diu),877 (Haryana).

Sex-selective abortion

Unequal sex ratio in India has been attributed to female infanticides and sex-selective abortions among more urban populations, rich and educated equally. Most states of India, especially Jammu and Kashmir, Punjab and Haryana, have much lower sex ratios according to 2011 census. This has been attributed to increasing misuse and affordability of foetus sex-determining devices, such as ultrasound scan, the rate of female foeticide is rising sharply in India. Female infanticide (killing of girl infants) is still prevalent in some rural areas. Though sex selection and selective abortion were banned in India under Pre-conception and Pre-natal Diagnostics Technique Act in 1994. The practice continues illegally.

Economic Inequalities

Most women labour force participates in the informal sector. Women's participation in

the formal labour sector is low, comprising only 19% of the sector. Seventy percent of women in the formal sector work in the public sector.

Women have low access to credit due to lack of collateral or property. Women have

equal rights under the law to own property and receive equal inheritance rights, but in practice, women are at a disadvantage. This is evidenced in the fact that 70% of rural land is owned by men. Laws, such as the Married Women Property Rights Act of 1974 protect women, but few seek legal redress. Although the Hindu Succession Act of 2005 provides equal inheritance rights to ancestral and jointly owned property, the law is weakly enforced, especially in Northern India.

Consequences (disadvantages) of Uneven Sex Ratios

* Though some increase is sex ratio has taken place in census 2011 but the slow pace of improvement shows that in next 20 years in large parts of India there will be an excess of males. These men will remain single and will be unable to have families, in societies where marriage is regarded as virtually universal and social status and acceptance depend, in large part, on being married and creating a new family.

* An additional problem is that many of these men are rural peasants of low socioeconomic class and with limited education. When there is a shortage of women in the marriage market, the women can “marry up,” inevitably leaving the least desirable men with no marriage prospects. For example, in China 94% of all unmarried people age 28– 49 are male and 97% of them have not completed high school. So, in many communities today there are growing numbers of young men in the lower echelons of society who are marginalized because of lack of family prospects and who have little outlet for sexual energy. A number of commentators predict that this situation will lead to increased levels of anti-social behavior and violence and will ultimately present a threat to the stability and security of society.

* There is also evidence that, when single young men congregate, the potential for more organized aggression is likely to increase substantially. Hudson and Den Boer, in their provocative writings on this subject, go further, predicting that these men are likely to be attracted to military or military-type organizations, with the potential to be a trigger for large-scale domestic and international violence. With 40% of the world's population living in China and India, the authors argue that the sex imbalance could impact regional and global security, especially because the surrounding countries of Pakistan, Taiwan, Nepal, and Bangladesh also have high sex ratios.

* It is natural that if sexual needs are to be met this will lead to a large expansion of the sex industry, including its more unacceptable practices such as coercion and trafficking.There is much reported evidence regarding increases in trafficking of women, both for the sex industry and marriage in India.

* It has also been suggested that a shortage of women may lead to a rise in homosexual behavior.

Suggestions for Improvement of Sex Ratio

(1) It is not enough to make laws alone, but motivation of people to adopt a human

attitude to female child should be taken up. Attitudinal changes are required. A women’s movement related to this issue like advertising etc should be taken up.

(2) Society should take firm stand because people condemning in public and practicing privately, only add on to the existing problem. The social stigma against wife to have a male child needs to be removed.

Issues of Child and Infant Mortality

When a new born infant dies within one year of his life, it is called IMR. Almost 50% of who die in one year of age dies in the first month; this is called Neo Natal mortality. Those babies, who die in the first week is called early Neo Natal mortality. If the child dies before 5 years of age, it is child mortality.

Infant mortality and child mortality are due to socio-economic dimensions. Neo Natal and early Neo-Natal mortality are due to medical reasons, though an element of socioeconomic reasons also lies.

Infant and child mortality are the indicators of the level of socio-economic development in society. IMR is high in developing countries low in developed countries. Same is the case with child mortality. IMR is mainly because of delivery related issues like Tetanus, which is due to non-usage of sterile material to cut umbilical cord. IMR is also due to respiratory disorders, water borne diseases like diarrhea, lack of access to health care facilities, absence of immunization against various diseases.

Interestingly both IMR and CMR have a direct bearing on birth/fertility rate. Societies where IMR and CMR is high tend to have high birth/fertility rate. Infant mortality creates deep insecurity in parents. As difference in ages between husband and wife in India is more and because longevity of female is more than male, women in India always fear that she has to spend 5 to 10 years of her life as a widow for which she wants a male child. So, they would go for pregnancy till they get a male child, adding more number of children to existing stock. This insecurity is directly related to high fertility and nonacceptance of Family planning.

IMR, CMR have strong connection with status of women. Children born to mothers who are less than 20 years of age are more prone to die. Also early marriage is due to the reason, that she has no formal education and because of being a dropout. So, by educating women, age of marriage can also be raised.

Measures for Prevention of IMR and CMR

* Nutritional status of women is very important. Women should have good dietary

supplements during pregnancy. Anemic mothers give birth to children of low weigh who are more likely to deaths.

* Also the spacing of children is important. Children born with a gap of less than 18

months have great chance of mortality. Realization of the importance of gap between two children requires women to be educated. Not only that, she should be able to exercise choice whether to go for pregnancy or not for which private patriarchy needs to be liminated atleast.

* Children born outside health care institutions have less chance to survive. Institutional deliveries are required. Government is now trying to train mid wives for to mitigate the danger of deaths of children.

* Access to various kinds of health care institutions is important. Diarrhea is a major

child killer. Immunizations against measles, polio, small pox etc are required for

survival of child. For this there should be availability of PHC and community hospitals

etc.

* Child should be breast fed for the initial 6 months atleast. Breast fed child in the first hour of his/her birth has a high chance of survival and would develop a good immune system. Breast fed immunizes baby as nothing else does. But for this to happen, women need to have good dietary supplements.

So, all factors are related with status of women.

Issue of Reproductive Health

The year 1994, was a turning point year in terms of our approach for population policy. International conference on population and development was held at Cairo in 1994. In the conference, there was a general criticism of third world countries because of target oriented approaches to family planning. Sterilization by force and inducement is a negative approach/attitude and the conference adopted a positive approach.

Instead of fixing demographic targets, it was emphasized that focus should be on needs of people i.e. one of the needs realized is RCH. RCH denotes reproductive and child health. Child health namely in terms of IMR, CMR access to various nutrients for children, which prevent disorders.

What is Reproductive Health?

A state of physical, mental and social well being in all matters relating to reproductive

system and its function and processes. So, people should be able to have a healthy sexual life. Women should have freedom to decide on reproduction. They must have access to safe, effective, affordable and acceptable methods of family planning. People should have knowledge about birth control measures and a right to information about appropriate health care services which will enable women to go through pregnancy, child birth and provides mother the chances to have a healthy child. India abandoned target oriented approach from 1996. We adopted RCH approach to family welfare. This indicates a positive change from 8th plan onwards.

RCH approach in India with focus on reproductive health

(1) Services for prevention and management of unwanted pregnancy. For this access to safe, effective, affordable and safe contraceptive measures.

(2) Promotion of safe motherhood. There should be antenatal care, institutional

deliveries assisted by trained persons and also prevention of maternal mortality.

Our RCH programme which included child survival and safe motherhood fixed a target of 100/100000 MMR (Maternal Mortality Rate). Millennium development goals and NRHM also emphasized on controlling MMR and bringing MMR down to 100/100000 by 2012. 50% of mothers’ deaths are due to hemorrhage and Septic which is all the more painful and could be easily avoided. 8% mothers die at time of abortion and 5% mothers die due to obstructed labor. 76% of all maternal mortality is there in BIMARUO+ Assam region. In the four Southern state MMR is only 10%.

These statistics strongly suggests the need to safe prevention care and following safe methods of delivery.

(3) Nutritional services for vulnerable groups, women and child.

(4) Prevention of sexually transmitted diseases and reproductive tract infections.

(5) Special provisions of reproductive health services for adolescence.

RCH is directly connected to fertility rate. So, need is to educate, spread awareness,

provide access to health care. As long as entire society is not included into the ambit, goals will be a distant dream.